Santana Lisgelia, Mills Katherine
Department of Anesthesiology, 13535 Nemours Parkway, Nemours Children's Hospital, Orlando, FL 32827, USA; University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA.
University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA.
Int J Pediatr Otorhinolaryngol. 2017 Sep;100:39-43. doi: 10.1016/j.ijporl.2017.06.023. Epub 2017 Jun 22.
This study evaluated the effect of intranasal dexmedetomidine on emergence delirium (ED) in pediatric patients who underwent ear tube surgeries. Due to the brief nature of the surgery and low levels of pain experienced, an IV is rarely needed, limiting the medications available to anesthesiologists to manage postoperative delirium that may arise during recovery from inhalational anesthesia. Intravenous dexmedetomidine is an alpha-2 agonist anesthetic that is used in pediatric patients for the management of ED in various surgical procedures. However, intranasal medication has not been evaluated specifically in ear tube surgeries for ED prevention.
We conducted a retrospective chart review of pediatric patients at Nemours Children's Hospital who had undergone ear tube insertion or removal surgery between 2013 and 2015, controlling for confounding variables such as age, surgery duration, and anesthesiologist. We used the post anesthesia emergence delirium (PAED) tool, an instrument created to assess ED in the clinical setting. We analyzed the data for significant differences in PAED score and time in the post anesthesia care unit (PACU) between patients treated with intranasal dexmedetomidine and the control group that did not receive the medication.
We found no significant difference between the PAED scores of those patients treated with intranasal dexmedetomidine prior to ear tube surgeries and those who did not receive the medication, and no difference in the duration of PACU stay.
These results conflict with other research on intranasal dexmedetomidine and its potential to prevent ED in pediatric patients. This information should prompt further prospective investigation into the most efficacious use of dexmedetomidine for ED prevention, both in terms of timing and dosage required.
本研究评估了鼻内给予右美托咪定对接受耳管手术的儿科患者术后谵妄（ED）的影响。由于手术时间短且疼痛程度低，很少需要静脉输液，这限制了麻醉医生用于处理吸入麻醉恢复过程中可能出现的术后谵妄的药物选择。静脉注射右美托咪定是一种α-2激动剂麻醉药，用于儿科患者在各种外科手术中处理ED。然而，鼻内用药在预防耳管手术中的ED方面尚未进行专门评估。
我们对2013年至2015年间在Nemours儿童医院接受耳管插入或取出手术的儿科患者进行了回顾性病历审查，控制了年龄、手术持续时间和麻醉医生等混杂变量。我们使用了麻醉后苏醒期谵妄（PAED）工具，这是一种在临床环境中评估ED的工具。我们分析了鼻内给予右美托咪定的患者与未接受该药物的对照组在PAED评分和麻醉后护理单元（PACU）停留时间方面的显著差异数据。
我们发现，在耳管手术前接受鼻内右美托咪定治疗的患者与未接受该药物治疗的患者的PAED评分之间没有显著差异，PACU停留时间也没有差异。
这些结果与其他关于鼻内右美托咪定及其预防儿科患者ED潜力的研究结果相矛盾。这些信息应促使进一步进行前瞻性研究，以确定右美托咪定在预防ED方面的最有效使用方法，包括给药时间和所需剂量。
